Certain medications used to treat HIV can
Lipodystrophy is a condition that changes the
way your body uses and stores fat. You may lose fat (called lipoatrophy) in
some areas of your body—usually in the face, arms, legs, or buttocks. You may
also accumulate fat (called hyperadiposity) in some areas, most commonly in the
back of the neck, breasts, and abdomen.
These changes in appearance can cause
anxiety, but don’t worry. There are several approaches to managing the
Switch Your HIV Medications
Some HIV medications—such as protease
inhibitors (Pls) and nucleoside reverse transcriptase inhibitors (NRTIs)—are
known to cause lipodystrophy. If this is the case, the easiest solution is to
switch medications. Taking a different medication can stop the progression and
may even result in improvement.
However, stopping your medications is a
decision that requires careful consideration of your overall health. Don’t just
stop taking your medications! Ask your doctor if another medication is a better
option for you.
The Role of Diet and Exercise
There is no specific diet for treatment of
lipodystrophy. However, a healthy diet plays an important role in overall
health and in maintaining a suitable body weight. Aim for a diet rich in
omega-3, fruits and vegetables, and fiber.
Avoid foods that are high in calories and carbohydrates,
but low in nutritional value. Though they may be tempting, fad diets or rapid
weight-loss schemes will only stress you out.
Exercise may help your body’s ability to
regulate insulin and burn off extra calories. Aerobic and strength-building
exercises help to build strong muscles too.
In 2010, the U.S. Food and Drug Administration (FDA) approved
a growth hormone releasing factor (GRF) called tesamorelin (Egrifta) for
treatment of HIV lipodystrophy. The medication, which consists of powder and a
diluting agent, must be stored in the refrigerator and away from light. You mix
it together by rolling the vial in your hands for about 30 seconds. Once a day,
you’ll have to inject it into your abdomen.
Side effects may include redness or rash,
swelling, or muscle and joint pain.
Liposuction can remove fat from targeted
areas. Your surgeon will mark your body before beginning. Either local or
general anesthesia is required.
After injecting a sterile solution to help
with fat removal, your surgeon will make tiny incisions to insert a tube under
your skin. The tube is connected to a vacuum. Your doctor will use a back and
forth motion to suction fat from your body.
Side effects may include swelling, bruising,
numbness, or pain. Risks of surgery include puncture or infection. Fat deposits
may eventually return.
Fat can be transplanted from one part of your
body to another. In a procedure similar to liposuction, fat is harvested from
the abdomen, thighs, buttocks, or hips. It is then cleaned and filtered. Your
surgeon will inject or implant it where needed, most commonly the face.
Fat can also be frozen for later use. The big
advantage is that by using your own fat, you face lower risk of allergic
reaction or rejection.
Facial Filler: Poly-L-lactic Acid
Poly-L-lactic acid (Sculptra, New-Fill) is an
FDA-approved facial filler that is injected into the face. The procedure is
performed by a doctor. Your doctor may stretch the skin while slowly giving the
injection. Following the injection, patients are generally given a 20-minute
massage at the injection site. This helps the substance to settle into place.
Ice is used to decrease swelling.
Side effects may include site pain or
nodules. Risks include allergic reaction and injection site abscess or atrophy.
It is usually necessary to repeat the procedure after a year or two.
Facial Filler: Calcium Hydroxylapatite
Calcium hydroxylapatite (Radiesse, Radiance)
is a soft-tissue filler FDA-approved for treatment of lipoatrophy in those who
are HIV positive.
During the procedure, your doctor will insert
a needle into your skin and push the plunger. They’ll slowly inject the
substance in linear threads while withdrawing the needle.
Side effects include injection site redness,
bruising, numbness, and pain. The procedure may need to be repeated.
There are a variety of facial fillers in use today, including:
(PMMA; Artecoll, Artefill)
collagens (Zyderm, Zyblast)
collagens (CosmoDerm, CosmoPlast)
These are temporary fillers, so it may be
necessary to repeat the procedure. Not all of these methods are recommended for
people who are HIV positive. Ask your doctor about the possible risks of these
substances and procedures.
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- Calcium hydroxylapatite. (n.d.). Medscape
Reference. Retrieved July 18, 2013 from http://reference.medscape.com/drug/radiesse-calcium-hydroxylapatite-999826
- FDA approves Egrifta to treat Lipodystrophy in
HIV patients. (2010, November 10). News
release, U.S. Food and Drug
Administration. Retrieved July 17, 2013 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm233516.htm
- Lipodystrophy. (2005, October). AIDS
info, U.S. Department of Health and
Human Services. Retrieved July 17, 2013 from http://www.aidsinfo.nih.gov/contentfiles/lipodystrophy_fs_en.pdf
- Lipodystropy in HIV – Treatment & Management. (2013,
July 15). Medscape Reference.
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- Liposuction – Risks. (2013, March 14). Mayo Clinic Staff, Mayo Clinic. Retrieved
July 18, 2013 from http://www.mayoclinic.com/health/liposuction/MY00079/DSECTION=risks
- Liposuction – What you can expect. (2013, March 14). Mayo Clinic Staff, Mayo Clinic.
Retrieved July 18, 2013 from http://www.mayoclinic.com/health/liposuction/MY00079/DSECTION=what-you-can-expect
- Poly-L-lactic acid/carboxymethylcellulose/mannitol. (n.d.). Medscape Reference. Retrieved July 18,
2013 from http://reference.medscape.com/drug/sculptra-aesthetic-poly-l-lactic-acid-carboxymethylcellulose-mannitol-999827
- Restorative Treatment Approaches for HIV-Associated Lipodystrophy. (2005,
September). Jeffrey S. Roth, MD, PhD, Physicians Research Network.
Retrieved July 17, 2013 from http://www.prn.org/index.php/complications/article/restorative_treatment_hiv_associated_lipoatrophy_73
- Shah M.
et al. (2005, July). The role of diet, exercise and smoking in dyslipidaemia in
HIV-infected patients with lipodystrophy. HIV
Med. 2005 Jul;6(4):291-8. Retrieved July 17, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/16011535?dopt=Abstract
- Terry L. et al. (2006,
March). Exercise training in
HIV-1-infected individuals with dyslipidemia and lipodystrophy. Med Sci Sports Exerc 2006
Mar;38(3):411-7. Retrieved July 17,
2013 from http://www.ncbi.nlm.nih.gov/pubmed/16540826?dopt=Abstract
- Tesamorelin (Rx) –
Egrifta. (n.d.). Medscape Reference.
Retrieved July 18, 2013 from http://reference.medscape.com/drug/egrifta-tesamorelin-999613
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